Provider Demographics
NPI:1457314601
Name:BAUDER, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:BAUDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 WILLOW CREEK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1645
Mailing Address - Country:US
Mailing Address - Phone:928-458-7343
Mailing Address - Fax:928-257-4422
Practice Address - Street 1:1000 WILLOW CREEK RD
Practice Address - Street 2:SUITE G
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:928-458-7343
Practice Address - Fax:928-257-4422
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ15235207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249872Medicaid
AZ249872Medicaid
AZZ91772Medicare PIN